Patient Registration

Please take a few minutes to fill out you paperworks here. This will allow us to process all the information and be ready for your first visit. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

If you do not wish to complete your paperworks online (here), you should arrive 10-15 minutes early so you can fill out the paper version. 

Again thank you for choosing Premier Dentistry - Kevin Jalali DDS PLLC and we look forward to meeting you shortly.

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